Determining a Learning Curve for Complex Laparoscopic Gastrointestinal Surgery. The purpose of this project is to validate the Global Operative Assessment of Laparoscopic Skills (GOALS) as an assessment tool and define the learning curve for complex laparoscopic gastrointestinal surgery. Using previously recorded data from a centralized database of the Fellowship Council, we will analyze the performance scores of surgical fellows when performing six different operations. There are three phases of the analysis. Since various factors impact technical performance, we will first correlate factors such as previous experience and case difficulty with performance scores as measured with GOALS. Second, by comparing performance scores of fellows at the beginning of the fellowship year with their scores at the end of the fellowship year, we will determine whether GOALS can differentiate novice fellows from graduating fellows and establish construct validity. Third, we wil define the learning curve in this small grant project by plotting performance over time through the academic year while accounting for previous experience and other factors that might impact the curve. The innovation in this project is the use of a national data set to determine the learning curve for surgical fellows for complex gastrointestinal (GI) operations. This should provide solid evidence on which to define the necessary components of technical surgical training and a tool with which we can implement proficiency-based training.